| NPI | 1275956492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810004576) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 4460) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 0140911) | |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2014-01-23 |